MALONE — The University of Vermont Health Network announced Tuesday that it will no longer perform non-emergency births or obstetrical care at Alice Hyde Medical Center.

“This is a difficult decision for our organization, and we know it is difficult news for our community,” Michelle LeBeau, UVM Health Network president of Alice Hyde and Champlain Valley Physicians Hospital, said in a statement. “Our priorities are to make this transition safe and seamless for expectant mothers, and to ensure they continue to have access to maternity services of the highest quality, in an environment of compassion and clinical excellence.”

LeBeau said that Alice Hyde will focus on delivering outpatient and emergent care to expectant mothers, and will continue providing pre- and post-natal care, gynecological care and surgical services, and women’s health services such as screenings, well visits and routine care.

“Responding to the changing needs of our community is nothing new for Alice Hyde — or for any health care organization — and it does not change our commitment to clinical excellence, delivering compassionate care, or to ensuring critical women’s health services are available to our patients and communities, now and for generations to come,” LeBeau said.

At a press conference Tuesday afternoon, Rebecca Shutts, chief nursing officer at Alice Hyde, said that no layoffs from the closing of the hospital’s maternity unit — known as the Family Maternity Center — are planned.

“We actually are not planning any layoffs at all,” Shutts said. “We worked with the staff to find spots for them to land safely.”

Lisa Mark, Alice Hyde’s chief medical officer, said that 10 or 11 nurses were working in the FMC. Some chose to leave the organization entirely and others chose to go to different areas of the organization, she said.

“Today’s announcement is devastating to North Country families, who will now be forced to drive an extra hour to have their babies,” Congresswoman Elise M. Stefanik, R-Schuylerville, said in a press release. “In the face of this loss of a critical component of care, supporting our health care workers and preventing staffing shortages that have been exacerbated by harmful vaccine mandates could not be more important. I will continue to advocate for our rural communities to have access to the healthcare services they need.”

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The deciding factor

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According to Ira Bernstein, chief of Women’s Services at UVM Medical Center and chair of the department of obstetrics, gynecology and reproductive services at UVM’s Larner College of Medicine, the deciding factor to close the FMC was primarily the drastic decline in the number of births performed at Alice Hyde since 2019.

“Like many rural hospitals, Alice Hyde has seen a significant decrease in births in recent years,” Mark said in a statement. “This decline in volume makes it difficult for our team to remain prepared for complex and/or difficult births, as well as complications that can arise during pregnancy.”

The decision to close the FMC came after a review of the program and was made in collaboration with the state Department of Health.

Alice Hyde said births at FMC have dropped by more than 46%. In 2019, the FMC delivered 258 babies. In 2021, there were 137 births.

While not a key factor in the closure, staffing shortages were also acknowledged.

In October, Alice Hyde began diverting expectant mothers from its birthing unit to other obstetrics programs in the region. A diversion is a temporary status that is declared after hospitals determine they are unable to provide a service in accordance with their standards.

Alice Hyde declared a diversion status after two traveling nurses left the FMC team in the middle of their contracts, leaving the hospital unable to fully staff its birthing unit and perform scheduled inpatient births with the level of quality and safety to meet its internal standards, according to the hospital.

Although the FMC closed on Oct. 4 due to pandemic-related staffing issues, LeBeau believes that the FMC’s closing was an eventuality due to the decrease in births.

Bernstein said staffing challenges are being felt across the country by obstetrics programs similar to Alice Hyde’s, as birth rates fall and both rural and metropolitan hospitals grapple with a shortage of obstetricians and gynecologists.

“Recruiting providers is no easy task, and finding providers interested in working in smaller communities where call is more frequent is an even bigger challenge,” Bernstein said. “I’ve been in this community and connected to Alice Hyde for 35 years, and because of the demographics in our region, the challenges are going to get worse, not easier.”

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Assurances going forward

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For obstetrical care, Alice Hyde will adopt a regional approach in which patients will be transferred to another facility of the patient’s choosing, continuing the diversion status indefinitely.

During the press conference, LeBeau said that Alice Hyde is partnering with Saranac Lake’s Adirondack Medical Center, Canton-Potsdam Hospital, and Plattsburgh’s Champlain Valley Physicians Hospital.

Mark said the other hospitals have the capacity to handle patients from northern Franklin County.

“We have been putting plans in place since we have been on diversion in October in order to be ready for such things.” Mark said. “We have put in place an OB nurse navigator in the OB-GYN office here (at Alice Hyde Medical Center) that helps moms choose where they would like to deliver. If they choose a location like CVPH, we have a variety of things in place so that moms can get to know the providers there that will be delivering them and the unit on which they will deliver.”

The OB nurse navigator is confirmed to be a permanent position at Alice Hyde.

According to LeBeau, Alice Hyde has worked directly with expectant mothers in the hospital’s care to share information and help facilitate the planning process for those whose delivery care plans have been impacted since diversion of maternity patients to neighboring programs began in October.

“Making this transition safe and seamless for expectant mothers is at the top of everyone’s mind, and I’m incredibly grateful for the work our FMC team continues to do each day to support and care for our patients as we work through this process,” LeBeau said. “Building a strong, regional program through collaboration with our partners across UVM Health Network, and working with our Regional Transport Center to give patients options as they travel to another facility to give birth, will ensure our community continues to have access to safe, reliable and high-quality maternity services.”

The UVM Health Network’s Regional Transport Center works with more than a dozen organizations that provide ground and air-based medical travel around the clock, every day of the year.

RTC also offers different levels of care ranging from basic and advanced life support to pediatric and neonatal intensive care unit services.

“We are committed to continuing to work in partnership with Alice Hyde, CVPH, UVMMC, other north country facilities, and transport agencies across our region, to connect moms and families with the care they need,” said Ryan Clouser, medical officer for the RTC. “We will also partner with these transport agencies to augment OB and perinatal training, to ensure we can support moms while in transit.”

Mark said Alice Hyde will continue to provide emergency care to expectant mothers through the hospital’s emergency department.

“Our emergency department team is trained and prepared to handle emergency situations as they arise, and members of our FMC team continue to be available in order to answer questions and provide support to patients with questions or concerns; and provide clinical support to our ED team, in the event of urgent or emergent deliveries,” Mark said.

Shutts said that following an emergency delivery, the mom and baby will be transferred to another facility to remain in a hospital setting as needed.

“It’s really important for us to acknowledge the really good work of the staff,” LeBeau said. “This has not been an easy six months for them. They have been fantastic, they have been professional, and they have been thoughtful and meaningful. They put patients in the center of the work that they are doing to make sure that we provide the best care for the community of Malone. It would be unfair to tell the story of this transition without highlighting these folks because they have really done spectacular work.”